Choose your Community. Harbor B2C Sales Bridge B2B Sales Crossroads Startup Founders Summit Executive Leaders SummitMembership Application About You Name * First Name Last Name Email * Phone * Country (###) ### #### Date of Birth * MM DD YYYY Company & Role Company Name * Current Role/ Title (Owner, Founder, Majority Stakeholder) * Industry or Sector * Agriculture and Food Production Distribution and Logistics Education and Training Energy and Utilities Finance and Banking Healthcare and Pharmaceuticals Hospitality and Tourism Manufacturing Media and Entertainment Non-profit and Social Enterprises Professional Services (e.g., Consulting, Legal, Accounting) Real Estate and Construction Retail and Consumer Goods Technology Telecommunications Other (Type Below) Other (if Industry or Sector is not listed) Business Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Website * http:// Business Description * Financial Information Annual Revenue * Less than $500,000 $500,000 - $1 million $1 million - $2.5 million $2.5 million - $5 million $5 million - $10 million $10 million - $25 million $25 million - $50 million $50 million - $100 million $100 million - $250 million $250 million - $500 million $500 million - $1 billion More than $1 billion Number of Employees * 1-4 employees 5-9 employees 10-19 employees 20-49 employees 50-99 employees 100-249 employees 250-499 employees 500-999 employees 1,000-4,999 employees 5,000-9,999 employees 10,000 or more employees Venture-back Companies Amount of privately-raised or publicly-raised funds Professional Background * Years of Experience in Leadership Roles * 1 - 5 Years 5 - 10 Years 10 - 15 Years 15 - 20 Years 20 - 30 Years > 30 Years Motivations & Goals Reason for Joining * Specific Professional Goals (5 Years) * Compliance & Commitment * Read agreements below before submitting this application. Click the buttons below to accept these agreements. Code of Conduct Non-Disclosure and Confidentiality Agreement Terms of Use Additional information Is there any additional information we should consider with this application? Thank you! AgreementsClicking a link will open a new tab. You will not lose your work.Code of ConductNon-Disclosure and Confidentiality AgreementTerms of Use Contact UsTalloo1120 S Rackham WaySte 300Meridian, ID 83642Phone: (208) 995-3436 Email Privacy Policy Form 2 5 Name * First Name Last Name Email * Subject * Message * Thank you!
